General medical and specialty mental health service use for major depression

Objective: While major depression is common, many depressed persons receive , at best, inadequate treatment. A first step in remedying inadequate detec tion and treatment of major depression requires understanding the pathways into treatment-from situations of no care, to disease recognition, to refer ral and appropriate treatment-as well as identifying factors associated wit h movement between these several stages. Methods: Using the Epidemiologic C atchment Area sample, we identified factors associated with treatment in th e general medical or mental health specialist section, or no treatment in a subsample of individuals with current major depression. Results: Strikingl y, one-fourth of the sample received no services, over half received care i n the general medical sector, and only one-fifth accessed a mental health s pecialist. Among those receiving any health services (general or mental), m en and respondents reporting suicidal symptoms were at risk of receiving no care, while perceived poor health and a cluster of core depressive symptom s were associated with increased odds of service use (general or mental). A mong respondents receiving general medical services, perceived poor health, core depressive symptoms, a history of depression, and comorbid mental con ditions increased the odds of treatment in the specialty mental health sect or. Conclusions: The findings emphasize the need for public health initiati ves to 1) improve detection and movement into treatment among those at risk of receiving no care; and 2) insure that, once within the health care syst em, the processes of primary care treatment and specialty referrals conform to evidence-based treatment guidelines.